Patient follow-up

Implementing a recall and reminder system for the follow up of tests, results, referrals and appointments in the practice is essential for continuing care and preventative care.

Recall systems are used to recall patients when something is ‘clinically significant’ and requires follow up. Clinically significant results do not necessarily mean ‘abnormal’ results. It is a judgement made by the practitioner that something is clinically important for that patient in the context of their health care.

Reminders are used as preventive activities for patients and do not have to be followed up if the patients does not attend the practice. It is recommended the reminder is noted in the health records for ongoing care.

Key points on recalls and reminders

• Contact details - Ensure they are up-to-date – it is advisable to check them regularly, i.e. 3-6 monthly, which may mean at each consultation in some contexts
• Communication - Ensure the patient understands the importance of responding to a recall, including the possible consequences of not attending
• It takes a team - To ensure recall and reminder systems are effective, fail-safe, and sustainable involves the whole team, including practitioners, administrative staff and patients – there needs to be a system in place that all practice members know and understand
• Recording results - Pathology results, imaging reports and clinical correspondence received should be reviewed, actioned, and incorporated in the patient’s health record
• Paper-based recall systems - A book is usually kept for recalling abnormal results. A designated staff member should be responsible for monitoring it. Each time the practitioner indicates a result for recalling, the patient’s details should be recorded in the book.  Details recorded should include:
  • Patient name, date of birth, medical record number and contact details
  • Reason for recall
  • Date of recall and method  e.g. letter, phone call, email, SMS, registered mail.
    • An entry noting the recall and its method should be made in the patient’s health record
• Electronic health records – Most have recall and reminders systems, but they are only as good as the information entered. Requesting a ‘read-receipt’ of computer generated recalls and reminders may be useful
• How far do you go? The number of attempts to follow up a patient should reflect the clinical significance. Generally, three attempts by a mix of methods (i.e. letter, SMS, phone and/or email) should be made.  One of those methods should be in writing, and for recalls detailing the potential implications of failing to return.  Utilising registered mail is advisable for your final attempt. Avoid using clinical information in SMS or email communications.

Further Resources

RACGP Standards - System for follow up of tests and results